How do you get there now?______________________________________________
Where do you go?______________________________________________________
How do you get there now?_______________________________________________
Do you use any of the following mobility aids or specialized equipment?
Service AnimalLong White Cane
Power ScooterOversized Wheelchair
THE HELP OF SOMEONE ELSE, CAN YOU…
Ask for and understand written or spoken instructions?
AlwaysSometimesNever Not Sure
Cross the street?
Stand for 10 minutes if there is no place to sit?
Step on and off a sidewalk from the curb?
Walk up and down three (3) twelve (12) inch steps?
Stand on a moving bus holding onto a handrail?
Find your own way to the bus stop if someone shows you once?
Transfer from one fixed route bus to another bus?
Walk up and down three (3) twelve (12) inch steps with handrail?